In the previous funding period this project focused on identifying areas of the brain essential for spatial attention in distinct reference frames and modalities, by identifying areas of tissue dysfunction associated with specific spatial attention deficits immediately after right or left hemisphere ischemic stroke in 661 patients. MRI scans, including diffusion weighted imaging and perfusion weighted imaging, were used to identify dysfunctional tissue, along with cognitive tests to identify specific types of hemispatial neglect within 24 hours of stroke onset. Repeat MRI and cognitive testing determined which deficits recovered in association with tissue recovery in specific regions by Day 3- 5. This work has shed some light on mechanisms of spatial attention and their neural correlates, as well as the cognitive impairments that underlie various types of hemispatial neglect. In the course of this work, the investigators noted the frequency and importance of other deficits that are frequently associated neglect -- such as loss of empathy and emotional expression -- particularly in individuals with right hemisphere stroke. These deficits have an enormous impact on the dignity of the individuals and on their relationships with spouses and other caregivers. Along with hemispatial neglect, they are among the most common and disabling consequences of right hemisphere stroke. In the next funding cycle, the project will use the same innovative methodology to identify and characterize the nature and neural correlates of two potentially related impairments that frequently co-occur with neglect: (1) loss of empathy and (2) affective aprosodia (impairment in one or more aspects of understanding and producing language with appropriate intonation, rate, pauses, and stress to convey emotion), and their association with hemispatial neglect, loss of sympathy, and other negative behavioral changes perceived by caregivers. The effects of age, brain volume, stroke volume, and metabolic factors, as well as location of dysfunctional tissue on the degree of impairment will be determined. Patients will be studied longitudinally through 6 months, to determine the factors, such as improved regional blood flow, that contribute to recovery. PUBLIC HEALTH RELEVANCE: This research will contribute to the understanding of the neural and cognitive mechanisms underlying the ability to recognize and respond to emotions of others and to the ability to understand and express emotions through tone of voice, by studying stroke patients in whom these abilities are often impaired. A better understanding of these impairments and how they recover is essential, because of the impact of these deficits on the interpersonal relationships of stroke survivors. The results will also have clinical impact by aiding in functional prognosis in acute stroke, and in identifying appropriate candidates for intervention to restore blood flow in patients with such deficits due to acute stroke.